Journal of the Formosan Medical Association最新文献

Background: To identify the possible factors correlated with the outcomes of initial non-shockable rhythm cardiac arrest patients who received target temperature management (TTM).

Materials and methods: We utilized the Taiwan Network of Targeted Temperature ManagEment for CARDiac Arrest (TIMECARD) registry and selected patients with initial non-shockable rhythm as the study group from the registry. The primary outcome was a favorable neurologic outcome. Univariate and multivariate analyses were performed to identify significant variables.

Results: A total of 332 patients with initial non-shockable rhythm were selected. The factors significantly affecting neurologic outcome were pre-arrest CPC 1, in-hospital cardiac arrest event, an initial rhythm of PEA, received bystander cardiopulmonary resuscitation (CPR), a shorter CPR duration, a higher systolic blood pressure at return of spontaneous circulation (ROSC), a higher diastolic blood pressure (DBP) at ROSC, without new-onset seizure, experience of hypokalemia, and received percutaneous coronary intervention. The results of multivariate analysis revealed that patients with initial rhythm of PEA, higher DBP, without new-onset seizure, and experience of hypokalemia were associated with better neurologic outcome.

Conclusions: Initial non-shockable cardiac arrest patients who had initial rhythm of PEA, higher DBP at ROSC, hypokalemia but no new-onset seizure may be correlated to better neurologic outcome after TTM.

Trial registration:

Clinicaltrials: gov: NCT03578328.

Background: COVID-19 severity affects liver damage. The utilization of various anti-COVID-19 drugs in non-severe cases related to liver impairment in the short term seemed intriguing.

Objectives: To assess the dynamic course of liver injury in mild to moderate COVID-19 patients within 10 days of admission and identify risk variables, including medication linkage.

Methods: This prospective cohort study of 300 newly diagnosed mild to moderate COVID-19 cases between September 2021 and October 2022. Tertiary center hospitel, field hospital, or cohort ward admissions were made. Patient demographics and treatment were recorded. The drug, liver injury (LI) dynamics, and clinical course were evaluated.

Results: Hospitel/field hospital (188) and cohort wards (112) had 300 individuals. One hundred fifteen participants had liver damage. Favipiravir (45 %), remdesivir (17.4 %), molnupiravir (11.3 %), Andrographis paniculata (ADG) (8.7 %), and favipiravir plus ivermectin (7.7 %) were given to most LI group (n = 104). The baseline AST/ALT levels of 68 (65.4 %) treated patients were abnormal. Favipiravir, remdesivir, and favipiravir + ivermectin increased mean AST/ALT in participants with normal baseline AST/ALT (p = 0.001, 0.003, and 0.016, respectively), but not molnupiravir or Andrographis paniculata. Transaminase levels climbed in untreated patients independent of baseline. The ground-glass imaging pattern was linked to mild LI. Most subjects had transaminase declines after 10 days. Preexisting liver disease did not increase the likelihood of in-hospital LI.

Conclusion: In the real world, a less-than-critical level of liver damage was reported in mild to moderate COVID-19 that allows clinicians to administer a variety of standard medications during short periods of hospital stay.

Background: Advance care planning (ACP) discussions and do-not-resuscitate (DNR) directives are essential for ensuring quality end-of-life care, especially for older adults with multiple comorbidities. This study aimed to investigate the prevalence and associated factors of informal ACP discussions and DNR directives among geriatric outpatients in Taiwan.

Methods: A cross-sectional study was conducted among 276 Taiwanese geriatric outpatients aged 65 years and older. Data on demographics, comorbidities, functional status, informal ACP discussions, and DNR directives were collected. Multinomial logistic regression was used to analyze the association between independent variables and dependent variables (ACP discussion experience and DNR directives).

Results: While 92.1 % of participants reported having informal ACP discussions, only 8.3 % had completed DNR directives. Compared to those who only discussed ACP (reference group), individuals with a one-point higher Cumulative Illness Rating Scale for Geriatrics score were significantly more likely to have both discussed ACP and completed DNR directives (odds ratio [OR] = 1.14, 95 % confidence interval [CI]: 1.01-1.29, p = .035). Conversely, individuals with junior high school education or higher (OR = 0.25, 95 % CI: 0.08-0.84, p = .025) and those dependent on others for activities of daily living (ADL dependence; OR = 0.24, 95 % CI: 0.07-0.86, p = .029) were significantly less likely to have neither informally discussed ACP nor completed DNR directives.

Conclusion: While Taiwanese older outpatients often informally discussed ACP, the completion of DNR directives was less common. The link between higher geriatric comorbidity and DNR directives highlights the need for proactive, tailored interventions in this population.